Supply of interventional cardiologists and the provision of lower-value Percutaneous Coronary Interventions (PCI)

Figures

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  Fig 1. PCI Providers/Million Population (PCI-Provider Density) and Average Hospital Lower-Value PCI Provision Rate by Hospital Referral Region (HRR). Authors’ analysis of data on the geographic supply of PCI-performing clinicians from CMS, [23,24] and 100% sample of Medicare Fee-For-Service claims and Medicare Advantage encounter data from 2019-2021. HRR = Hospital Referral Region. Lower-value PCI provision rate = percent lower-value PCIs among total PCIs, calculated at the hospital level as described in the manuscript, and then averaged across all hospitals within each HRR, using weights equal to the total number of PCIs performed in each included hospital. For both PCI-provider density and lower-value PCI provision, HRRs are divided into quintiles of approximately equal numbers of HRRs for color-coded presentation in this map. We used shape files provided by the Dartmouth Atlas [35] (for HRRs) or IPUMS (for state/national borders) [30,36] to draw this map.

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  Fig 2. Mean Hospital Lower-Value PCI Provision Rate by HRR-level PCI-Provider Density Quintile (n = 1,580). Authors’ analysis of data on the geographic supply of PCI-performing clinicians from CMS, [23,24] and 100% sample of Medicare Fee-For-Service claims and Medicare Advantage encounter data from 2019–2021. PCI-provider density = PCI providers per 1,000,000 HRR population; hospitals were divided into quintiles by the PCI provider density, each with a roughly equal number of hospitals as follows: quintile 1 = 316 hospitals, quintile 2 = 317 hospitals, quintile 3 = 318 hospitals, quintile 4 = 315 hospitals, quintiles 5 = 314 hospitals.

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  Fig 3. Unadjusted and Adjusted Association between the Hospital-Level Lower-Value PCI Provision Rate and HRR-level PCI-Provider Density Quintile (n = 1,580). Authors’ analysis of data on the geographic supply of PCI-performing clinicians from CMS [23,24] and 100% sample of Medicare Fee-For-Service claims and Medicare Advantage encounter data from 2019–2021, with covariate data drawn multiple data sources as described in the manuscript. PCI-Provider Density = PCI providers per 1,000,000 HRR population. Hospitals were divided into quintiles by the PCI provider density, each with a roughly equal number of hospitals as follows: quintile 1 = 316 hospitals, quintile 2 = 317 hospitals, quintile 3 = 318 hospitals, quintile 4 = 315 hospitals, quintiles 5 = 314 hospitals. See S1 Appendix for CPT codes used to define PCI providers. HRR Population covariates include the percentage of the HRR population aged 40–64 years, percent 65–74 years, and percent 75 + years; the percent of the non-elderly population that is uninsured; the percent of the adult population (18 years and older) with a physician diagnosis of coronary heart disease; and the median household income (inflation adjusted in 2021…